Overview
Measurable residual disease (MRD) monitoring has become a critical component in the management of acute myeloid leukemia (AML) in remission 1. This monitoring informs prognosis, guides therapy, and serves as a key endpoint in clinical trials 1. Updated guidelines provide a refined framework for MRD assessment, tailored to individual prognostic and genetic subgroups 1.Diagnosis
MRD monitoring is a critical methodology for assessing response and risk of treatment failure in AML 1.
MRD assessment guidelines are aligned with the European LeukemiaNet (ELN) 2022 genetic risk classification 1.
A new qualitative MRD response category (optimal, warning, or high risk of treatment failure) has been introduced to facilitate contextual interpretation of the MRD burden and its clinical relevance 1.Management
MRD monitoring is used to guide therapy in AML 1.
MRD recommendations are tailored to individual prognostic and genetic subgroups to inform management decisions 1.
Ultrahigh-sensitivity next-generation sequencing (NGS)-based MRD assessment is recommended for FLT3* internal tandem duplication (ITD)-mutated AML after intensive chemotherapy and before allogeneic hematopoietic cell transplantation 1.Key Recommendations
Measurable residual disease (MRD) monitoring is a critical component in the management of acute myeloid leukemia (AML) to inform prognosis, guide therapy, and serve as a key end point in clinical trials 1. (Evidence: Expert opinion)
MRD recommendations should be tailored to individual prognostic and genetic subgroups 1. (Evidence: Expert opinion)
A new qualitative MRD response category (optimal, warning, or high risk of treatment failure) should be used to facilitate contextual interpretation of the MRD burden and its clinical relevance 1. (Evidence: Expert opinion)
Ultrahigh-sensitivity next-generation sequencing-based MRD assessment is recommended for FLT3 internal tandem duplication-mutated AML after intensive chemotherapy and before allogeneic hematopoietic cell transplantation 1. (Evidence: Expert opinion)References
1 Cloos J, Valk PJM, Thiede C, Döhner K, Roboz GJ, Wood BL et al.. 2025 update on MRD in acute myeloid leukemia: a consensus document from the ELN-DAVID MRD Working Party. Blood 2026. link
2 Döhner H, Estey EH, Amadori S, Appelbaum FR, Büchner T, Burnett AK et al.. Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood 2010. link